• Med Princ Pract · Jan 2024

    Factors affecting the second complete atypical femoral fracture after the first atypical fracture.

    • Hiroyuki Tsuchie, Yuji Kasukawa, Koji Nozaka, Hayato Kinoshita, Ken Sasaki, Toshiaki Aizawa, Motoki Mita, Kentaro Ouchi, Yusuke Yuasa, Takanori Miura, Takenori Tomite, Shigeto Maekawa, Hidekazu Abe, Manabu Akagawa, Nobusuke Shibata, Masashi Fujii, Masaaki Takeshima, Jyunichi Inoue, Hikaru Saito, and Naohisa Miyakoshi.
    • Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Hondo, Akita, Japan.
    • Med Princ Pract. 2024 Jan 1; 33 (1): 102010-20.

    ObjectivesAtypical femoral fracture (AFF) is an atypical low-energy subtrochanteric and diaphyseal femoral fracture. Even if bone fusion is achieved in patients with AFF, the risk of AFF in the contralateral femur must be considered. This study aimed to investigate the factors affecting complete AFF in the contralateral femur and conservatively treated incomplete AFF.Subject And MethodsRadiographs of 111 femurs in 104 AFF cases were examined, and the femurs were classified as follows: 85 contralateral femurs with complete AFF; 18 contralateral femurs with incomplete AFF; 8 femurs with incomplete AFF without surgical treatment. Various patients' clinical data were collected, and we investigated the factors affecting the second complete AFF.ResultsComplete fractures occurred in 10 (9.7%) of 103 femurs without incomplete AFF at the first visit and in 3 (37.5%) of 8 femurs with incomplete AFF. The Kaplan-Meier curve revealed that lateral cortical bone thickening and thigh pain were associated with significantly poorer prognoses (p = 0.026 and p = 0.013, respectively). Multivariate analyses revealed that eldecalcitol usage after AFF onset (p = 0.0094) and previous use of bisphosphonate or denosumab (p = 0.0126) were protective factors for second complete AFF and that the presence of thigh pain (p = 0.0134) was a risk factor for second complete AFF.ConclusionsEldecalcitol administration after bone union of first AFF may prevent AFF recurrence. In addition, painful incomplete AFF has a high risk of developing a complete fracture.© 2023 The Author(s). Published by S. Karger AG, Basel.

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